A woman in her early 20s or 30s who may have trouble getting pregnant, or a woman who is concerned about irregular periods, hot flashes, night sweats and vaginal dryness may find that she has primary ovarian insufficiency.

This can be one of the hardest diagnoses for a woman to face.

What is Primary Ovarian Insufficiency?
Primary Ovarian Insufficiency (POI), previously called “premature ovarian failure (POF) is when menopause occurs before the age of 40. POI occurs in 1 in 1,000 women between the ages of 15-29 and 1 in 100 women between the ages of 30-39. Twenty seven is the average age of onset.

Women with POI have complete or near complete ovarian follicular depletion with resulting low estrogen and high Follicle Stimulating Hormone (FSH) levels. They often will experience menopausal symptoms such as hot flashes, night sweats and vaginal dryness and will rarely ovulate.

Some women with POI can still ovulate and menstruate and may be able to conceive. However, the odds are low. According to the National Institute of Health, between five to ten percent of woman with POI have conceived and have carried normal pregnancies without medical assistance.

Who is at risk?
In about half the cases, a reason for POI is not found. However, we know that women with a family history of POI are at greater risk. The condition is also associated with autoimmune disorders affecting the thyroid and adrenal glands. And it is also linked to genetic causes such as Turner and Fragile X syndrome. Additionally, women exposed to chemotherapy and radiation are at greater risk for POI.

Long-term effects
The low estrogen levels associated with POI may make women particularly prone to develop osteoporosis and early heart disease. Women may also be at a greater risk for depression. If POI in a particular case is linked to a genetic condition, then there might be a risk to future children.

Emotional impact
This can be an emotionally devastating diagnosis for many young women. Dreams of motherhood and ideas about self worth may be challenged. At the same time, they may have to deal with the physical symptoms of menopause years before their peers. This can take an emotional toll on one’s psyche and relationships. Counseling and support are available.

Treatments
There is no cure for POI, just as there is no cure for aging eggs. Many women don’t find out about this condition until their FSH level is measured when they see a doctor because their periods are irregular or nonexistent.

To achieve pregnancy, a woman with POI may opt to undergo IVF with her own or with a donor’s eggs. Additionally, a woman with POI will likely be advised to take supplemental estrogen in order to avoid some of the detrimental effects that low estrogen can have on her bones and heart.

We are often asked this question by patients who are at a crossroads in their treatment. Deciding to use the genetic material of another woman to have a baby is typically made with a lot of thought, deliberation and soul-searching.

Here are some questions to consider as you move forward in our family building journey.

Do you have a pre-existing condition?
Some women arrive at our office knowing they will need an egg donor. They may have lost their fertility because of cancer treatment or a medical condition that caused their ovaries to be removed or stop functioning. Other women may carry an incurable genetic disease they don’t wish to pass to their future children and don’t want to genetically screen their embryos.

Are you older than the age limit for your clinic?
Many fertility clinics have upper age limits for females past which they will not perform IVF with a woman’s own eggs. From their experience, they feel the IVF success rates are too low to justify the time and expense of this procedure versus the results. This can be a frustrating policy for patients, but one developed from the experience of the particular clinic.

Do you have weak ovarian reserve?
Every female fertility patient undergoes several fertility assessment tests. These tests provide an overview of the approximate number of eggs remaining in her ovarian reserve as well as her potential response to fertility medications. None of the tests can evaluate egg quality, though we know this declines with age.

Your doctor will discuss the test results with you so you can make a joint determination about whether to proceed with further treatment using your own eggs. Often women need to see if they can beat the odds with their own eggs before moving on to another family building procedure. Usually an IVF cycle, especially one combined with genetic screening, can provide patients with valuable information about the odds of conceiving with their own eggs.

Have you experienced multiple IVF and pregnancy losses?
Women who decide to use donated eggs frequently have experienced multiple losses with their own eggs, including failed IVF cycles and miscarriages. When you are producing abnormal eggs and embryos, it’s probably time to make other choices.

Is experiencing pregnancy and childbirth important to you?
The loss of passing your genetic characteristics to your child can be perceived as a profound loss. However, using donor eggs also gives you many benefits. Donor egg with IVF enables women to experience pregnancy and childbirth, take care of their baby prenatally, and nurse their child.

Using donated eggs also allows the female’s partner to be genetically related to their child, which is an important consideration for many couples.

Learn more about HRC Fertility’s egg donation program, one of the most experienced and successful in the United States. Visit http://www.havingbabies.com/infertility-treatment/egg-donation-program/.

That is a question many millennial women are asking themselves. Should they freeze time and their biological clock by undergoing oocyte cryopreservation, the medical term for egg freezing, or will Mr. Right come along before their fertility is reduced?

At HRC Fertility, we are seeing an increased interest in “social” egg freezing as the technique becomes more popular and effective. Some employers, such as Google and Facebook, have even begun offering this benefit, realizing their female employees want more reproductive choices.

Though there is no “one size” fits all answer, the women who come to our clinic to inquire about their options generally look at these factors to make a decision: current age; finances; professional and education goals; relationship status; desire to become a mom and have children.

What do women really need to know about egg freezing?
Before they embark on their egg freezing journey, the typical twenty or thirtysomething woman should know the answers to these questions about preserving their fertility.

What is the best age to freeze my eggs?
Ideally, women should freeze their eggs in their late 20s or early 30s when their fertility potential is highest. The older a woman is, the more eggs she will need to have retrieved to maximize her chances of a pregnancy when she uses them. This might mean several egg retrieval cycles.

How are eggs frozen?
The largest cell in the human body, the egg, is mainly comprised of water that can form ice crystals when frozen, which damages the cell. At our laboratory, we freeze eggs using a flash freeze process known as vitrification. First, however, we add an “anti-freeze” to prevent crystallization. Vitrification was a major advancement over the slow freeze method previously used.

What is the egg retrieval process like?
Similar to IVF, egg freezing requires a series of hormone injections and monitoring of your hormone levels and ovaries. When th eggs have matured, they are retrieved using transvaginal guided ultrasound while the patient is under anesthesia.

What happens when I want to use my eggs?
We will thaw your eggs and combine them with the sperm of your choosing. Current estimates indicate that up to 75 percent of eggs survive thawing with 75 percent of those fertilizing and growing into embryos.

About 2,000 babies have been born from egg freezing, and there have been no reports of higher birth defects or abnormalities with these babies. Experts currently believe eggs can remain frozen indefinitely, although there have been no studies of eggs frozen more than 10 years.

What if I don’t use my eggs?
Many women have found that frozen eggs gave them peace of mind to pursue their professional goals and/or to move with their lives without worrying about losing their chance to have a baby. Many find partners and get pregnant the “old fashioned” way but are glad they took out this fertility insurance plan.

Who else should freeze their eggs?
For women facing a cancer diagnosis, freezing their eggs can be a game changer for life after their cancer is cured or in remission. We highly recommend they undergo an egg retrieval before starting life-saving, but fertility-damaging treatment.

Two other types of patients might also want to consider egg freezing: those who have moral or religious objections to excess embryos and women with a family history of premature menopause.

At HRC Fertility, we firmly believe that young women who think they someday want kids should take charge of their fertility. Knowledge is power, and we encourage them to educate themselves about fertility in general and egg freezing in particular.

Traci’s children Connor and Cassie are two years apart, yet their origins began at the same time in the HRC Fertility laboratory. Like many IVF babies, they are frozen embryo twins.

Traci and her husband began trying to get pregnant about a year after their 2011 wedding. When nothing happened, Traci sought the advice of her gynecologist, who found that her progesterone levels were too low to sustain a pregnancy. After several months of taking Clomid without getting pregnant, her doctor referred her to Dr. David Tourgeman at HRC.

Dr. Tourgeman initially recommended three rounds of IUI. When those didn’t work, the couple decided to undergo IVF, which produced four embryos. Dr. Tourgeman transferred the two healthiest embryos, one of which became Connor.

“After Connor’s first birthday, we decided to transfer the other two stored embryos even though the prognosis for their development wasn’t all that optimistic,” Traci recalls. “There was only a 30 percent chance of pregnancy, but luckily one developed into our new baby daughter Cassie.”

Traci is very appreciative of the support she received from HRC, adding, “The staff can make or break a patient’s experience because we’re visiting the clinic so often. Most of the nurses were experienced working in the infertility field, plus they had children of their own and understood how important this was to me. Dr. Tourgeman and the entire staff were excellent at explaining what I needed to know about my cycle to make it a success.”

Traci is enjoying her new role as the busy mother of two young, active and healthy children. She is also thankful for the many wonderful infertility resources that were available to her and her husband. Going forward, she is happy to be part of the conversation to help people talk more about infertility. Even though the process was emotionally challenging, Traci knows she was in the best of hands with HRC.

Amy, a 48-year-old medical marketing executive from San Clemente, easily conceived her three older children: an 18-year-old son and 16-year-old daughter from her first marriage and a three-and-a-half year-old from her second.

However, Amy and her husband Diego wanted a sibling for their youngest. After trying unsuccessfully to conceive, the couple realized they were facing secondary infertility and would need the help of an infertility specialist. Amy’s OBGYN recommended Dr. Jane Frederick. Dr. Frederick suggested Amy go through one round of IVF to see if she could produce any of her own eggs, but none were found.

“Of course it was disappointing because we’d been so hopeful,” recalls Amy. “In the same discussion, Dr. Frederick recommended egg sharing as a solution.”

The couple quickly found a donor who looked like Amy and had been matched with one other person. Within a week, they were matched with her. Four out of the five fertilized eggs proved viable, and Amy and Diego chose a male embryo. The best news: Amy became pregnant with her first donor cycle, had a model pregnancy and gave birth to Sam earlier this year.

Though Diego never had second thoughts about using an egg donor, Amy tried to reconcile their objective to expand their family with new technology.

She says, “I kept reflecting on the bigger picture of what we were trying to accomplish while being in awe of the new advances that could be executed so easily. In the back of my mind, I feared I might feel differently about a child not genetically related to me. But those concerns immediately evaporated when Sam was born.”

Overall, Amy says she had an amazing experience with Dr. Frederick and her staff. Though the process was complex, she applauds the HRC Fertility team members for being great communicators, educators and problem solvers who were available whenever they were needed.

“We felt cared for from the first appointment until we delivered our baby — and even after that,” she says. “Dr. Frederick and all the employees seemed genuinely happy for us, like we were partners working together to achieve our goal. She and her staff held our hands through a nerve-wracking experience and gave us the best possible outcome. We will always consider Dr. Frederick Sam’s first doctor.”